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What you need to know

Quality evidence to say whether over-the-counter treatments work for nasal symptoms of the common cold is limited.

For adults, consider a trial of decongestants alone, or with antihistamines or analgesics to alleviate bothersome nasal symptoms.

Do not prescribe decongestants to children under 12, as evidence of their effectiveness is limited and associated risks may exist.

The common cold is usually caused by viruses and is mostly self limiting,1 but it can have a substantial impact on work, school,2 use of health services, and money spent on medications. Children have around 6-8 colds per year and adults have 2-4.34

Many over-the-counter (OTC) treatments for the common cold claim to alleviate nasal symptoms, such as congestion, rhinorrhoea (runny nose), and sneezing. Table 1 lists commonly used drugs. Evidence for the effectiveness of these treatments is limited and of low quality, and clear guidance is lacking.5 Long term use of nasal decongestants is known to lead to chronic nasal congestion.6

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Table 1

Drugs used to treat symptoms in common cold

What is the evidence of uncertainty?

Search strategy and study selection

We searched the Cochrane Library for systematic reviews that investigate the effectiveness of treatments for the common cold. If only a protocol or no Cochrane review was available, we searched PubMed for other systematic reviews on the topic. If no systematic reviews were found, we searched for individual randomised controlled trials of commonly used treatments (fig 1, table 2). We extracted data on the subjective severity and duration of nasal symptoms (nasal congestion, rhinorrhoea, and sneezing) and adverse events. We extracted the number of studies and participants, and where available, used pooled results. If pooled results were not available, we assessed whether the findings were in favour of the active treatment.

Adults

We found Cochrane reviews on treatments such as decongestants, antihistamines, analgesics, intranasal corticosteroids, herbal remedies, and vitamins …